ITEMS IN AFP WITH MESH TERM:
ABSTRACT: Coronary heart disease is the most common cause of death in the United States. The conventional risk factor approach to primary prevention excludes many patients who could benefit from preventive therapies. A global risk approach allows more accurate estimates of risk to guide clinical primary prevention efforts. Global risk of coronary heart disease is a calculation of the absolute risk of having a coronary heart disease event (e.g., death, myocardial infarction) over a specified period. It is based on an empiric equation that combines major risk factors, such as blood pressure and cholesterol levels. When physicians know a patient’s global risk of coronary heart disease, they are more likely to prescribe risk-reducing therapies such as antihypertensives, statins, and aspirin. In addition, patients who know their risk level are more likely to initiate risk-reducing therapies. Many tools are available to estimate global risk, including several Web-based calculators. In the United States, tools based on the Framingham Heart Study are recommended.
For Hyperlipidemia, Go Where the Evidence Takes You: Give a Statin and Nothing Else - Editorials: Controversies in Family Medicine
The Role of Nonstatin Therapy in Managing Hyperlipidemia - Editorials: Controversies in Family Medicine
Updated Recommendations on Daily Aspirin Use in Patients with Diabetes - Practice Guidelines
ABSTRACT: Nearly one half of Americans die of cardiovascular disease. The morbidity and mortality associated with coronary artery disease is strongly related to abnormal lipid levels, oxidation of lipids and intra-arterial clot formation. Nutrition powerfully influences each of these factors. There is growing evidence that patients can improve lipid levels and decrease the rate of cardiovascular events by "adding" specific foods to their diets and switching from saturated and polyunsaturated to monounsaturated fats and n-3 fatty acids. Appropriate dietary changes decrease arteriosclerotic plaque formation, improve endothelial vasomotor dynamics, reduce oxidation of low-density lipoproteins and enhance thrombolytic activity. Brief discussions between physicians and patients can influence patients' food choices. Changes in diet can reduce the premature mortality and morbidity associated with coronary artery disease.
Preventing Congestive Heart Failure - Article
ABSTRACT: The morbidity, mortality and health care costs associated with congestive heart failure make prevention a more attractive public health strategy than treatment. Aggressive management of etiologic factors, including hypertension, coronary artery disease, valvular disease and excessive alcohol intake, can prevent the left ventricular remodeling and dysfunction that lead to heart failure. Early intervention with angiotensin converting enzyme inhibitors in patients with chronic left ventricular dysfunction can prevent, as well as treat, the syndrome. Several intervention strategies in patients with acute myocardial infarction can slow or prevent the left ventricular remodeling process that antedates congestive heart failure. The primary care physician must be alert to the need for aggressive intervention to reduce the burden of heart failure syndrome on the patient and on society.
Management of Dyslipidemia in Adults - Article
ABSTRACT: The importance of treating dyslipidemias based on cardiovascular risk factors is highlighted by the National Cholesterol Education Program guidelines. The first step in evaluation is to exclude secondary causes of hyperlipidemia. Assessment of the patient's risk for coronary heart disease helps determine which treatment should be initiated and how often lipid analysis should be performed. For primary prevention of coronary heart disease, the treatment goal is to achieve a low-density lipoprotein (LDL) cholesterol level of less than 160 mg per dL (4.15 mmol per L) in patients with only one risk factor. The target LDL level in patients with two or more risk factors is 130 mg per dL (3.35 mmol per L) or less. For patients with documented coronary heart disease, the LDL cholesterol level should be reduced to less than 100 mg per dL (2.60 mmol per L). A step II diet, in which the total fat content is less than 30 percent of total calories and saturated fat is 8 to 10 percent of total calories, may help reduce LDL cholesterol levels to the target range in some patients. A high-fiber diet is also therapeutic. The most commonly used options for pharmacologic treatment of dyslipidemia include bile acid-binding resins, HMG-CoA reductase inhibitors, nicotinic acid and fibric acid derivatives. Other possibilities in selected cases are estrogen replacement therapy, plasmapheresis and even surgery in severe, refractory cases.
Current Hypertension Control Is Just Not Good Enough - Editorials
ABSTRACT: The exercise stress test is a useful screening tool for the detection of significant coronary artery disease. Documentation of the patient's symptoms, medications, past and current significant illnesses, and usual level of physical activity helps the physician determine if an exercise stress test is appropriate. The physical examination must include consideration of the patient's ability to walk and exercise, along with any signs of acute or serious disease that may affect the test results or the patient's ability to perform the test. The test report contains comments about the maximal heart rate and level of exercise achieved, and symptoms, arrhythmias, electrocardiographic changes and vital signs during exercise. This report allows the clinician to determine if the test was "maximal" or "submaximal." The quality of the test and its performance add to the validity of the results. The conclusion section of the test report indicates whether the test results were "positive," "negative," "equivocal" or "uninterpretable." Further testing may be indicated to obtain optional information about coronary artery disease and ischemic risk if the test results were equivocal or uninterpretable.